Individual provider Active NPI

Fernando Gutierrez

  • Dentist
  • Pembroke Pines, FL
National Provider Identifier
1114230588
Registry record updated Jan 21, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DE60162008 Issued in WA
Practice address
9964 Pines Blvd
Pembroke Pines, FL 33024-6139
Phone
(954) 432-6222
NPI assigned
Jul 14, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DE60162008 WA Primary

Addresses

Primary practice location

9964 Pines Blvd
Pembroke Pines, FL 33024-6139

Mailing address

9964 Pines Blvd
Pembroke Pines, FL 33024
Phone (954) 432-6222

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160405000986 FL Order and Referring Only - DentistPractitioner - Dentist 9234436395

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DE60162008WAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Fernando Gutierrez DDS PA Dentist Current Accepting new patients
Pines Palm Dental Dentist Current Accepting new patients

Locations

9964 Pines Blvd
Pembroke Pines, FL 33024
Phone (954) 432-6222

Networks

  • Freedom Health HMO Network
  • HealthSun Health Plans Network

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1279065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421798400000",
    "number": "1114230588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9964 PINES BLVD",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "33024",
            "telephone_number": "954-432-6222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9964 PINES BLVD",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330246139",
            "telephone_number": "954-432-6222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUTIERREZ",
        "first_name": "FERNANDO",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-14",
        "last_updated": "2015-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE60162008",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pembroke Pines, FL

Sources for this page

Verify at the official NPI Registry.